title: Acquired hypogammaglobulinemia in HIV-positive subjects after liver transplantation.
abstract: BACKGROUND
  As more solid organ transplantations are performed in patients infected with human immunodeficiency virus (HIV), post-transplant complications in this population are becoming better defined.
  
  
  METHODS
  Using serum samples from the Solid Organ Transplantation in HIV: Multi-Site Study, we studied the epidemiology of acquired hypogammaglobulinemia (HGG) after liver transplantation (LT) in 79 HIV-infected individuals with a median CD4 count at enrollment of 288 (interquartile range 200-423) cells/μL. Quantitative immunoglobulin G (IgG) levels before and after LT were measured, with moderate and severe HGG defined as IgG 350-500 mg/dL and <350 mg/dL, respectively. Incidence, risk factors, and associated outcomes of moderate or worse HGG were evaluated using Kaplan-Meier estimator and proportional hazards (PH) models.
  
  
  RESULTS
  The 1-year cumulative incidence of moderate or worse HGG was 12% (95% confidence interval [CI]: 6-22%); no new cases were observed between years 1 and 2. In a multivariate PH model, higher pre-transplant model for end-stage liver disease score (P = 0.04) and treated acute rejection (P = 0.04) were both identified as significant predictors of moderate or worse HGG. There was a strong association of IgG levels <500 mg/dL with non-opportunistic serious infection (hazard ratio [95% CI]: 3.5 [1.1-10.6]; P = 0.03) and mortality (3.2 [1.1-9.4]; P = 0.04). These associations held after adjustment for important determinants of infection and survival among the entire cohort.
  
  
  CONCLUSIONS
  These results suggest that a proportion of HIV-positive LT recipients will develop clinically significant HGG after transplantation.
authors.affiliation: Department of Internal Medicine, Division of Infectious Diseases, University of Michigan Medical School, Ann Arbor, Michigan, USA.
authors.forename: K S
authors.initials: KS
authors.lastname: Gregg
authors.forename: B
authors.initials: B
authors.lastname: Barin
authors.forename: D
authors.initials: D
authors.lastname: Pitrak
authors.forename: C
authors.initials: C
authors.lastname: Ramaprasad
authors.forename: K
authors.initials: K
authors.lastname: Pursell
mesh_terms: D000328:Adult; D001424:Bacterial Infections / Q000453:epidemiology; D018791:CD4 Lymphocyte Count; D017074:Common Variable Immunodeficiency / Q000097:blood* / Q000453:epidemiology*; D003586:Cytomegalovirus Infections / Q000453:epidemiology; D058625:End Stage Liver Disease / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000453:epidemiology; D006679:HIV Seropositivity / Q000097:blood / Q000150:complications*; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood*; D015994:Incidence; D053208:Kaplan-Meier Estimate; D016031:Liver Transplantation / Q000009:adverse effects / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000453:epidemiology; D016016:Proportional Hazards Models; D012307:Risk Factors; D012720:Severity of Illness Index
chemical_list: D007074:Immunoglobulin G
keywords: HIV; hypogammaglobulinemia; infection; liver transplantation; mortality